Shingles (herpes zoster)
Last Reviewed: January 2023
What is shingles?
Shingles, also called herpes zoster or zoster, is a painful skin rash caused by the varicella-zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains inactive in the body. Usually, the virus does not cause any further problems; however, the virus may re-emerge years later, causing shingles. There is a vaccine to prevent shingles.
Who gets shingles?
Anyone who has recovered from chickenpox may develop shingles, including children (intrauterine exposure and varicella disease when younger than 18 months). However, shingles most commonly occurs in people 50 years old or older. The risk of getting shingles increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV) infections, or people who receive drugs that weaken the immune system, such as steroids and drugs given after organ transplantation, are also at greater risk to get shingles.
How is shingles spread?
A person must have already had chickenpox in the past to develop shingles. A person cannot get shingles from a person that has shingles. However, the virus that causes chickenpox and shingles can be spread from a person with active shingles to a person who has never had chickenpox or the chickenpox vaccine. The person exposed to the virus would develop chickenpox, not shingles. A person with shingles can spread the virus when the rash is in the blister-phase. The blister fluid is filled with virus particles. It usually appears on the trunk or face. The virus is spread through direct contact with the rash or through breathing in virus particles that get mixed in the air. The rash often lasts 7-10 days. Once the rash has developed crusts, which can take 2-4 weeks, the person is no longer contagious. A person is not infectious before blisters appear or if pain persists after the rash is gone (post-herpetic neuralgia). Immunocompromised people may experience a longer duration of symptoms.
What are the symptoms of shingles?
Shingles usually starts as a rash on one side of the face or body. The rash starts as blisters (vesicles) that scab after seven (7) to ten (10) days. The rash usually clears within two (2) to four (4) weeks.
Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, headache, chills, and upset stomach.
How soon do symptoms appear?
The virus lies dormant in someone who has had chickenpox in the past. It can reactivate many years later.
What are the complications associated with shingles?
Shingles is not usually dangerous to healthy individuals although it can cause great misery during an attack. Anyone with shingles on the upper half of their face, no matter how mild, should seek medical care at once because of the risk of damage to the eye. Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death. For about one (1) person in five (5), severe pain can continue even after the rash clears up. This pain is called post-herpetic neuralgia. As people get older, they are more likely to develop post-herpetic neuralgia, and it is more likely to be severe.
Is there a treatment for shingles?
Several antiviral medicines, acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), are available to treat shingles. These medications should be started as soon as possible after the rash appears and will help shorten the illness and decrease how severe the illness is. Pain medicine may also help with pain caused by shingles. Call your provider as soon as possible to discuss treatment options.
Does past infection make a person immune?
Usually. Most people who have shingles have only one episode with the disease in their lifetime. Although rare, a second or even third case of shingles can occur.
Is there a vaccine for shingles?
There is one shingles vaccine currently available, RZV or Shingrix . Shingrix vaccine is recommended for the prevention of shingles and its complications. Two doses of Shingrix given two (2) to six (6) months apart are recommended for healthy adults 50 years of age and older. Shingrix is also recommended for adults who have previously received ZVL or Zostavax or varicella vaccine. Shingrix is also recommended for persons 19 years and older who are or will be immunodeficient or immunosuppressed because of disease or therapy.
What can be done to prevent the spread of shingles?
A vaccine for chickenpox is available, and it is hoped that individuals immunized against chickenpox will be less likely to develop shingles in later life.
The risk of spreading the virus that causes shingles is low if the rash is covered. People with shingles should keep the rash covered, not touch or scratch the rash, and wash their hands often to prevent the spread of shingles. Once the rash has developed crusts, the person is no longer contagious.